Missouri DHSS - Vital Records Applications and Forms · Missouri state form
Mother’s Affidavit to Legitimate Birth Record VS-443
Use this affidavit to provide information for an amended birth record after marrying the child’s natural father and requesting a change to the child’s recorded name.
- What this form is
- The Mother’s Affidavit to Legitimate Birth Record collects information about the child, mother, father, and marriage to the child’s natural father. The mother swears that the information is true and complete and requests that the child’s name be recorded as indicated. Complete the form in black ink. The form requires the mother to sign in the presence of a notary.
- Who needs it
- A mother who has married the child’s natural father and wants the child’s name recorded as indicated on an amended birth record may use this affidavit.
- Why it needs a notary
- The mother must sign in the presence of a notary. This can be done online with a commissioned online notary.
- How to submit it
- The form says faxed, photographed, or reproduced copies will not be accepted and returned; it requires the original. Submit it to the Missouri agency named on the form.
Questions
Who uses the Mother’s Affidavit to Legitimate Birth Record?
The form is for a mother who has married the child’s natural father and wants the child’s name recorded as indicated on an amended birth record. It asks for information about the child, mother, father, and marriage.
Does the Mother’s Affidavit to Legitimate Birth Record need to be notarized?
Yes. The form says the mother’s signature must be made in the presence of a notary and includes a notary jurat. The signature can be notarized online with a commissioned online notary.
Can I submit a fax or copy of this affidavit?
No. The form states that faxed, photographed, or reproduced copies will not be accepted and will be returned. It requires the original, completed in black ink.